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Medico-Marketing Manual

INDEX

SR. NO. TOPIC PAGE NO.

1 Role of Skin 2

2 Skin Infections 3

3 Skin Inflammation 8

4 Mixed Skin Infections 9

5 Mexaderm + Microemulsion Cream 12

6 Comparison – Microemulsion Cream & Ordinary Cream 13

7 Terbinafine – Role in Mexaderm + 14 – 15

8 Ofloxacin & Ornidazole – Role in Mexaderm + 15 – 16

9 Corticosteroids – Clobetasol Propionate – Role in Mexaderm + 17 – 18

10 Comparison – Mexaderm + and Other Preparations 19

11 Mexaderm+ - Indications, Dosage, Key Discussion Points 20

12 Mexaderm+ - Major Competitors 21

13 Derma Market – Categories, Segment, Top Brands 22

14 Oflo + Orni +Terbi + Clobeta - Market Size, Growth etc. 23

15 Top Competitor Brands - Market Size, Volume, Value & Growth 24

16 Mexaderm+ - Our Objective 24

17 Our Strategy – Mexaderm+ Marketing / Inputogram & Visit Plan 25 - 28

18 Indications - Glossary 29 - 36

Strictly Confidential: For in-house Circulation only.

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1. What is the role of skin?

The skin is the largest organ of the human body which protects the body and internal organs.

Some of the major functions (role) of the skin are as below:

Barrier function – Protects from environmental changes, external hazards & microorganisms

Prevention from excessive water loss & gain (TEWL)

Protection from UV rays

Regulation of body temperature

Sensation -Touch, Pain and Pressure

Excretion of toxic substances through sweat

Storage of water fats and Glucose

Synthesis of vitamin D

2. How skin protects the body?

The skin works as waterproof cushion to protect the body because of keratin which is a fibrous

protein present in the epidermis. The cells in the epidermis are tightly connected to each other,

thus microorganisms or other external material, environmental hazards and allergens cannot easily

pass through them. Moreover, epidermis is covered with a thin protective film called as ‘Skin’s acid

Mantle’ which is acidic in nature (pH 5.5 to 6) and does not allow the microorganisms to grow. Skin

and hair provides protection from UV rays and guards against sunburn by secreting melanin. The

skin sweats to excrete wastes and toxic substance and regulates body temperature. The skin

prevents dehydration by controlling the level of perspiration.

As long as the skin is intact and healthy, external hazards like, dirt, allergens & microorganisms

cannot enter in to the skin. If the skin has breaks, cuts, injured or has a blister or splinter in it, then

microorganisms and other external hazards can easily enter into the body and may cause an

infection or skin disease.

3. What is a skin infection?

Micro-organisms such as bacteria, fungi, viruses and others that can cause infections are all around

us i.e. in the air, water, soil and food, as well as in the bodies of animals and other people. Infection


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occurs when these microorganisms overcome the body's natural defense (immune) system, enter

in to the body, attach to the cells, grow and multiply.

These microorganisms (bacteria, fungi, virus and others) are also present on our skin. The skin

blocks these microorganisms and protects itself and the body through its natural defense

mechanism. The skin infections can be caused by the invasion & proliferation of a wide variety of

microorganisms. If the skin is oily, dry with rashes, scaly or itching & irritation, or comes in contact

with chemicals or allergens, it gets damaged with cracks and the microorganisms get favorable

conditions to grow. They get proliferated and cause skin infections. These infections can spread on

the skin and inside the skin and may also enter the bloodstream.

4. What are the symptoms of skin infections?

The symptoms of skin infection generally start with itching & irritation, inflammation (pain, heat,

redness & swelling), rashes, change in colour & texture of the infected area of skin. Sores, blisters

and lesions (flat, elevated or depressed) can also be the symptoms of skin infections. These

symptoms may vary depending on the type of infections (bacterial, fungal, viral or others). The Skin

infections can be localized or widespread (on large areas of the skin & inside the skin) and can also

enter the bloodstream causing systemic infections.

5. What are the different types of skin infections?

There are various types of skin infections based on the causative microorganisms i.e. Bacteria,

Fungi, and Virus etc. involved in it. The type of skin infection always depends on the cause e.g.

Folliculitis is a skin infection caused by a bacteria Staphylococcus aureus.


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Some common types of skin infections are as below:

Bacterial Infections – P. Acne, Folliculitis, Carbuncles, Furuncles, Boils, Impetigo etc.

Fungal Infections (Ringworm/Tinea) – T. corporis, T. cruris, T. unguium, T. pedis etc.

Yeast (Candida) Infections – T. versicolor, Oral thrush, Vaginal candidiasis

Viral Infections – Rubella, Herpes zoster, HPV (human papilloma virus) etc.

Skin infestation – These are caused by the organisms which stay and grow on the skin or

within the skin. E.g. Sarcoptes scabiei which causes scabies. Others are roundworm

infestation and Lice infestation etc.

Mixed Skin Infections – In mixed skin infections the primary infection may be caused by

bacteria or fungus and on that secondary infection develops.

The itchy skin with oozing, breaking out with rashes, hives (like bee hives) and eczema can also be

the examples of infected skin. Some skin infections can be minor, temporary and easily treated,

while others can be very serious and may develop into mixed infections.

6. Which are the microorganisms responsible for skin infection?

Skin infections can be mainly caused by the microorganisms like bacteria, fungi and viruses.

The most common causative pathogens are as below:

Bacteria - Staphylococcus aureus, Streptococcus pyogenes, Propionibacterium etc.

Fungi – Tricophyton rubrum, Microsporum canis, Epidermophyton floccosum, Candida

albicans etc.

Virus – Herpes zoster, Rubella, Vericella, HPV etc.

7. How infections occur on the skin?

Skin infections can be caused by the invasion, growth and proliferation of a wide variety of

microorganisms like bacteria, fungi, viruses, germs and others. These microorganisms are normally

present on the skin and in the body. They can enter in to the skin & proliferate if they get the

favorable conditions to grow such as rashes, breaks & cuts, burns, oily skin, hormonal changes or if

the skin’s or body’s immunity is down etc. These microorganisms may have uncontrolled growth,

thus can spread on the skin and inside the skin to cause severe infections. These infections can also

enter / spread in to the bloodstream and may lead to systemic infections.

8. What is a fungal infection of the skin?

The fungal infections are caused by the fungi which are the plants (microorganisms) without stems,

roots or leaves. They do not have Chlorophyll (hence can‘t survive on their own) therefore they

grow as Parasites (obtaining nutrients from living organisms) and Saprophytes (obtaining nutrients

from dead organic material).


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The fungi are classified as DYM (Dermatophyte – Yeast – Mold) which is based on their parasite or

saprophyte properties:

Dermatophytes: Fungi, which produce disease of the skin, hair and nail. These fungi grow as

saprophytes on keratin. There are three genera of dermatophytes which are Tricophyton,

Microsporum and Epidermophyton.

Yeasts: Single celled eukaryotic (cells having nucleus) fungi that produce disease of the skin

and its appendages (hair & nail) and especially where the mucous membrane is present e.g.

Oral candidiasis (thrush), Vaginal Candidiasis, Tinea Versicolor etc.

Mold and other fungi: These are multicellular fungi that produce extremely superficial

fungal infection. Mold infections generally originate from soil. E.g. Fusarium species,

Aspergillus species, Alternaria species etc. (Toe nail infection is the common example).

Fungi (fungus) invade and grow in dead keratin. Keratin is a protein that makes up the skin, hair

and nails. There are several different types of fungal infections. They are divided into different

groups depending on the type of fungus involved.

The symptoms and presence of a fungal skin infection depends on the type of fungus that has

caused it and also depends on the affected area of the skin / body.

Fungal skin infection causes skin rashes that are red, scaly and itchy or may produce fine scales

similar to dry skin. The fungal infection can be localized (limited to one area of skin) or widespread

(can spread to other parts of the body/skin).

Typical fungal infection known as ‘Ringworm infection’ because of ring shape (here no worm is involved in the infection)


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9. What are the types of fungal infections?

Fungal infections are broadly classified in to following two types,

Dermatophytes (Tinea - Ringworm) infections also called as dermatophytosis

Yeast (Candida) infections

Ringworm or Tinea (fungal) infections are known by the different names on the basis of location

of infected sites. Few of them are given below:

Tinea capitis: (Ring worm of scalp) - Caused most often by dermatophyte, tricophyton, and

microsporum. Scaly red lesions in which hair appears lusterless or dull.

Tinea corporis: (Ring worm of the chest and uppe body) -Most commonly caused by

trichophyton and microsporum species.

Tinea cruris: (Ring worm of the groin) - Caused by epidermophyton species.

Tinea unguium: (Ring worm of the nail) - Caused by T. rubrum (Onycomycosis).

Tinea barbae: (Ring worm of the beard also known as Barber’s itch) - Mostly caused by

Trichophyton species. Restricted to area of beard i.e. face, or neck in males.

Tinea manuum: (Ring worm of the hand ) -Mostly caused by Trichophyton species affects

palm and areas between the fingers

Tinea pedies: ( ring worm of the foot / Athlete’s foot ) - Caused by Trichophyton species and

Epidermophyton floccosum

The fungal infections of the skin which are caused by the yeast (candida) are called candidiasis

which generally affects mucous membrane & keratinous structure. The common examples are,

Intertrigo – It is caused by the species Candida albicans, which develops rashes between the

skin folds. The most common areas affected include larger skin-fold areas e.g. armpits,

under the breasts, genital area and abdomen etc.

Pityriasis versicolor (Tinea versicolor) – Infection caused by yeast Malassezia. It is also

called as Pityriasis versicolor. It causes a pink brown or red colour patches on skin. It usually

occurs on back, upper arms and torso.

Thrush (Candida albicans) - C. albicans is a common fungus that often lives in the mouth,

stomach, skin and vagina. Usually it doesn't cause any problems. However, if the person is

unwell, pregnant, taking antibiotics or having diabetes, the yeast can multiply and cause the

symptoms of thrush. It looks like small white patch that leaves a red mark if rubbed. In

women, vaginal thrush can cause itchiness and a white discharge.

Note - Details of the above infections are given on last (glossary) page.


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10. What is a bacterial infection of the skin?

Certain bacteria commonly live on the skin without causing any harm. However, these bacteria can

cause skin infections when the skin becomes excessively dry or oily. These bacteria enter the body

through cuts, open wounds, or other breaks, also when we scratch the skin. Bacterial infections are

the alteration of the normal skin into infected area/site that occurs when harmful form of bacteria

grows in number and proliferates on the skin and in body. They range from mild to severe.

Symptoms of bacterial infection may include redness, swelling, pain, or pus. Some common

bacteria that cause skin infections are Staphylococcus aureus and Streptococcus pyogenes.

11. What are the types of bacterial infections?

Types of Bacterial skin infection are Primary and Secondary bacterial infections. It depends on the

invasion and severity of bacterial infection. Usually scratching (nails) also causes bacterial infections

or worsens the infections. Some bacteria invade normal skin, broken skin from eczema/dermatitis

or wounds (causing wound infection). Bacteria may also sometimes result in rashes.

The major bacterial infections of the skin are Cellulitis, Boils, Impetigo, Acne, Folliculitis,

Carbunculosis & Furunculosis etc.

Some of the common bacterial infections of skin are given below:

Carbuncles - A carbuncle is a red, swollen, and painful cluster of boils that are connected to

each other under the skin.

Staph Infection - The infection often begins with a little cut, which gets infected with

bacteria. These staph infections range from a simple boil to antibiotic-resistant infections to

flesh-eating infections.

Cellulitis - Cellulitis is a common infection of the skin and the soft tissues underneath. It

happens when bacteria enter a break in the skin and spread.

Impetigo - Impetigo is a highly contagious bacterial skin infection. It can appear anywhere

on the body but usually attacks exposed areas. It looks like a bee hive in appearance.

Boils - A boil is a skin infection that starts in a hair follicle or oil gland. At first, the skin turns

red in the area of the infection, and a tender lump develops. After four to seven days, the

lump starts turning white as pus collects under the skin.


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Pilonidal Cyst and Abscess - A pilonidal cyst occurs at the bottom of the tailbone (coccyx)

and can become infected and filled with pus. Once infected, the technical term is pilonidal

abscess.

Note – Details of the above indications are given on glossary (last) page.

12. What is anaerobic infection?

Anaerobic infections are common infections caused by anaerobic bacteria (bacteria that do not

need oxygen to live). These bacteria are naturally occurring and plentiful in and on the body. They

don’t cause infection in their natural state; but these anaerobes cause infection after an injury or

trauma to the body, or under favorable conditions. These anaerobes also cause infections when the

body’s immunity (self-defense) is compromised where they get the favorable condition to grow and

multiply in number.

Anaerobic infections are often caused when deep tissues inside the body become injured and/or

exposed. This can be by injury, trauma, or surgery. Anaerobic infections could be severe skin

infections hence they are often difficult to treat. The most common example is acne caused by

anaerobe i.e. Propionibacterium acne, that naturally exist in our body / skin.

13. What is skin inflammation; how does it occur?

The word inflammation came from Latin i.e."inflammo = ‘I set alight, I ignite’.

Inflammation is the body's immune response to an injury, invasion or insult. It is body’s defense mechanism

i.e. the body's attempt of self-protection to remove harmful stimuli and begin the healing process.

Inflammation is characterized by pain, heat (temp.), redness and swelling (PTRS).

The inflammation of skin is called dermatitis (Derma = Skin & itis = Inflammation). If the skin is exposed to triggering factors, such as UV Rays, irritants (e.g. Soaps or fragrances etc.) or allergens, the cells in the skin produce a variety of inflammatory responses. It is the localized physical condition in which part of the skin becomes reddened, swollen, hot and often painful. Skin inflammation (dermatitis) is of various type e.g. Atopic dermatitis, Contact dermatitis, Nummular dermatitis and Seborrheic dermatitis etc. Skin inflammation can be characterized in 2 types Acute (rapid onset and quickly becomes severe)

and Chronic (this means long-term inflammation, which can last for several months and even

years).


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14. What is mixed skin infection?

Mixed skin infection is an infection by several microorganisms where numerous combinations of

bacteria, fungi and viruses may be involved. It is commonly seen in abscesses, injuries and

infections of wounds, burns and cuts. Mixed skin infection is also known as secondary fungal

infection involved with bacteria or secondary bacterial infection involved with fungi. E.g. Super-

infected eczematous skin condition.

15. How mixed skin infection develops?

Mixed skin infections can be caused by numerous aerobic & anaerobic bacteria and

development of fungi (Tinea & Candida) on the same. The mixed skin infections are also

called as Secondary fungal or secondary bacterial infection where the presence of both

either fungi or bacteria may be involved along with redness, inflammation and irritation.

Mixed skin infections could be developed in prolonged bacterial (aerobic & anaerobic)

infections with the growth of fungi (Tinea & Candida) as well as during prolonged fungal

infections with the growth of bacteria.

Mixed skin infections can also develop in cases of cuts, wounds and burns where first

bacteria (aerobic & anaerobic) and later fungi (Tinea or Candida) could be involved along

with inflammation.

Progression of Mixed Skin Infections

Skin Primary Fungal

Infection

Becomes

Eczematized

Oozing,

Weeping,

Itching,

Scaling

Secondary

Bacterial

Infection

Complicated

Skin Lesions

Skin Primary Bacterial

Infection

Becomes

Eczematized

Oozing,

Weeping,

Itching,

Scaling

Secondary

Fungal

infection

Complicated

Skin Lesions

Skin Cut, Wounds,

Burns

Secondary

Bacterial

Infections

Becomes

Eczematized

Attracts

Fungal

Infection

Complicated

Skin Lesions

16. Which are the types of mixed skin infections?

The mixed skin infection is the infection where numerous bacterial as well as fungal species are

involved. Types of mixed skin infection are often decided as per the severity of the symptoms and

the invasion of the pathogen at the affected area. Following are the types of mixed skin infections.


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Fungal infections developed into secondary infection after the invasion of bacteria

Secondary bacterial infections developed after the invasion of fungi

Infections developed in cases of cuts, wounds and burns where both bacteria (aerobic and

anaerobic) and fungi are involved.

Superinfected Eczematous conditions

17. Which are the treatment options available for Mixed Skin Infection?

The commonly used treatments for mixed skin infections are given below:

Topical anti-fungal – Imidazoles (Clotrimazole, Miconazole, Fluconazole etc.), Allylamines

(Terbinafine, Naftifine etc.)

Topical anti-bacterial - Wide range viz. Aminoglycosides (Kanamycin, Tobramycin, Gentamicin,

Neomycin etc.), Lincosamides (Licomycin & Clindamycin), Macrolides (Erythromycin,

Azithromycin etc.), Fluroquinolones (Nadifloxacin, Ofloxacin etc.)

Corticosteroids – Super potent (Clobetasol, Halobetasol), Very Potent (Betamethasone,

Beclomethasone), Moderate (Mometasone, Fluticasone) & Mild (Hydrocortisone, Fluocinolone)

Combination of a steroid with anti-fungal

Combination of a steroid with anti-bacterial

Anti-fungal, anti-bacterial and steroid combination for treatment of Mixed Skin Infections that

are caused by the bacteria and, or fungi (Secondary colonization)

The symptomatic inflammatory dermatophytosis with erythema, pruritus, and burning could be

treated by using synergistic combinations such as antibacterial, antifungal and, or anti-

inflammatory.

18. What are the drawbacks of available combinations / treatments?

Recurrence is a very common problem in the treatment of mixed skin infections because of the

presence of anaerobic bacteria which could not be properly treated with available triple

combinations. This is because they do not contain antibacterial that works against anaerobic

bacteria; hence they are not much effective in treatment of mixed skin infections.


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19. What is the better option for the treatment of mixed skin infections?

Generally the combination of topical steroid and antifungal drugs are used for the treatment of

dermatophytosis. Also the combination of an antifungal & corticosteroid, anti-bacterial &

corticosteroid or anti-bacterial, antifungal & corticosteroids could be used.

The steroids provide rapid symptomatic relief and control the inflammation while the antifungal

drug eradicates the causative fungal organism; an anti-bacterial provides the complete control over

secondary bacterial infections.

The combination of powerful antifungal and a potent corticosteroid along with antibacterial that

can cover both aerobic and anaerobic (bacterial) infections could be the better option for the

treatment of mixed skin infections to avoid recurrence.

20. Which innovative brand Glowderma is launching for the treatment of Mixed skin infection?

Glowderma is launching Mexaderm+ Microemulsion Cream which is an innovative

combination with a difference, for the treatment of Mixed Skin Infections.


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21. What are the ingredients of Mexaderm+ Cream?

Composition:

Ofloxacin 0.75% w/w,

Ornidazole 2.00% w/w,

Terbinafine Hydrochloride 1.00% w/w

Clobetasol propionate 0.05% w/w

In a Microemulsion cream base. q. s.

22. What is the innovation in Mexaderm+ Cream?

Mexaderm+ Cream is prepared in a special Microemulsion Cream Technology.

Microemulsion is a potential drug delivery system for more than one medicine simultaneously.

It is a novel vehicle used for delivery of actives which can enhance drug absorption with

reduced systemic side effects.

Microemulsion technology is used to form the ultrafine particles of the drug that increases the

transdermal penetration of actives.

Microemulsion enhances drug targeting without a simultaneous increase in systemic

absorption.

23. What are the advantages of microemulsion cream technology in Mexaderm+ Cream over

ordinary cream preparations?

The microemulsion cream technology has following advantages,

Microemulsion technology enhances absorption & penetration of the active drug in the Stratum

Corneum

Improves efficacy of the drug

Gives faster results

Minimizes side effects


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Penetration of Mexaderm+ Microemulsion Cream

Microemulsion Cream Ordinary Creams

Microemulsion cream has ultrafine globules

with particle size of 10 nm to 50 nm (Human

skin pore size is 50 nm to 100 nm)

Ordinary creams / normal skin care creams

has average particle size is 100 nm to 1000

nm

Prepared with an instant transparent system

using soluble active ingredients and

incorporated in a cream base.

These are the emulsion of oil & water in

approximately equal proportions with active

ingredients dispersed in it.

Offers enhanced absorption & penetration of

the actives in the SC

Has inadequate absorption and penetration

in the SC

Ensures better bioavailability of the actives

hence faster action

Poor bioavailability of the actives hence

slower action

Remains stable in all climatic conditions Stability of the ordinary creams is a concern

during climatic changes

Offers reservoir effect in the skin that prevents

recurrence

No proper reservoir effect hence increased

risk of recurrence

Ensures faster results Slower results

Minimal side effects Causes side effect like redness and irritation

of the skin at applied area


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24. What is Terbinafine Hydrochloride?

Terbinafine Hydrochloride is an allylamine anti-fungal having a broad spectrum activity against

fungal pathogens of the skin, hair and nails, including dermatophytes such as Trichophyton,

Microsporum, Epidermophyton floccosum, and yeasts of the genera Candida. Terbinafine is

fungicidal against dermatophytes, moulds and some dimorphic fungi. {Dimorphic fungi = A long

filamentous fungi} At room temperature it grows as a mold; at body temperature it grows as yeast.

25. What is the mode of action of Terbinafine?

The cell membranes of fungi are vital for their survival. They keep unwanted substances from

entering the cells and stop the contents of the cells from leaking out. The main substance which

helps to maintain the cell wall intact is Ergosterol.

Terbinafine causes inhibition of enzyme squalene epoxidase that leads to excess accumulation of

squalene, which has been shown to result in the fungicidal effect.

Excess accumulation of squalene is fungicidal (kills the fungi)

Deficiency of Ergosterol is fungistatic (Stops growth of fungi)

Essential for fungal survival & growth


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26. How Terbinafine is superior to other antifungals?

Terbinafine Miconazole, Clotrimazole &

Fluconazole

Terbinafine is an Allylamine antifungal These all are the imadizole derivatives

Terbinafine is a fungicidal even at low

dosage

Azoles are fungi-static in nature with low

dosage

Inhibits enzyme squalene epoxidase that

leads to excess accumulation of squalene,

which results in death of the fungus i.e.

fungicidal effect

Inhibits the fungal cytochrome P450

enzyme (α-demethylase) responsible for

converting lanosterol to ergosterol. This

leads to accumulation of peroxides

resulting in the inhibition of fungal growth

i.e. fungistatic effect

Terbinafine has the reservoir effects in to

the skin after application, hence no

recurrence

May have the chances of recurrence after

discontinuation of treatment

Duration of therapy is less Require long-term applications

Better efficacy and better patient

compliance

Less convenient for the patients because of

repeated applications required

27. What is Ofloxacin?

Ofloxacin is a synthetic broad-spectrum antibiotic belongs to fluroquinolone group of

antibacterials. Ofloxacin is active against both Gram-positive and Gram-negative bacteria.

28. What is the mode of action of Ofloxacin?

The Ofloxacin inhibits the bacterial enzymes required for their DNA replication, transcription,

repair and recombination to prevent the proliferation of bacteria. Ofloxacin cures the infection by

killing the bacteria hence is bactericidal in nature.

29. How Ofloxacin helps in treating mixed skin infections?

Ofloxacin is effective against both Gram-positive and Gram-negative bacteria. Ofloxacin also shows

good activity against staphylococcus aureus and various strains which are majorly responsible for

skin infections. Therefore, Ofloxacin helps to prevent the development of secondary infections and

acts against the bacterial infections of the skin.


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30. How Ofloxacin is superior to other topical antibacterial like Gentamicin and Neomycin?

Ofloxacin Gentamicin / Neomycin

A synthetic 2nd Generation antibacterial

belongs to the class of Fluroquinolone Aminoglycoside class of antibacterial

Inhibits the synthesis of DNA gyrase enzyme Acts on 30s subunit of ribosomes (RNA)

Broad spectrum antibacterial, effective

against both Gram +ve & Gram –ve Bacteria

Only effective against Gram - ve Bacteria

& Partially effective against Gram +ve

Bacteria

Can be used in all types of secondary

bacterial or mixed infections

Only can be used to treat minor skin

infections

Used in both dry and wet type of skin

infections

Only can be used in limited and dry types

of skin infections

Safe on long term use and does not cause

skin sensitivity

Both of them exhibits some toxic effects

in many people having allergic reactions

Very effective treatment with less chances of

bacterial resistance even after long term use

Develop resistance to certain bacterial

species after long term use

31. What is Ornidazole?

Ornidazole is broad spectrum antibacterial belongs to the class of 5-Nitro-imidazole derivative.

Ornidazole is used for treatment and prophylaxis of anaerobic infections. It has broad spectrum

bactericidal action against anaerobic bacteria. Ornidazole is known to interact with the DNA of

anaerobes resulting in the destruction of their DNA structure; it inhibits the protein synthesis

causing cell death in susceptible microorganisms.

32. What is the role (mode of action) of Ornidazole in mixed skin infections?

Mixed skin infections have some anaerobic bacteria involved. These anaerobes are single-celled

living organisms which reside in our skin in low oxygen environment, without causing any harm.

But the moment they get the favorable conditions (like cracks in the skin, deep seated wounds,

cuts and burns, weak immunity etc.) they grow & multiply in number causing infection. Ornidazole

enters into the cells of these anaerobes by diffusion. Nitro group of Ornidazole is reduced by the

proteins present in these anaerobes to reactive nitro radical, which applies cytotoxic action by

damaging their DNA and other critical biomolecules. Hence the DNA structure of the anaerobes

destabilizes, their DNA strand breaks resulting in the cell death of anaerobes.

Ornidazole inhibits the DNA structure of anaerobes (involved in mixed skin

infections) and selectively blocks their cell functions, resulting in their cell death.


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33. Which are the steroids available for the treatment of skin infection & inflammation?

Corticosteroids are the steroid hormones that are either produced by the body or prepared

synthetically. Corticosteroids can reduce inflammation (redness and swelling), suppress the

immune system and narrow the blood vessels in the skin. Their main purpose is to reduce skin

inflammation and irritation.

There are various topical corticosteroids available in different strengths, which are determined by

the amount of corticosteroid they contain. They are classified as below:

Mild Corticosteroids – Hydrocortisone, Fluocinolone etc.

Moderate Corticosteroids – Clobetasone, Mometasone, Fluticasone

Potent Corticosteroids – Betamethasone, Beclomethasone

Very Potent / Super Potent Corticosteroids – Clobetasol, Halobetasol, Ulobetasol etc.

34. How Clobetasol propionate is superior to other topical steroids?

Clobetasol propionate is a very potent steroid which has a strong action to control the

inflammation and redness, compared to other mild or mid potent steroids. Hence it offers quick

control over inflammation and pruritic conditions, with limited applications only. However, other

mild or mid-potent steroids require repeated applications to control the inflammation.

Clobetasol propionate

Beclomethasone dipropionate /

Betamethasone Dipropionate /

Mometasone /Other steroids

Super-high potency corticosteroid Mild to mid potent corticosteroids

Offers quick control on inflammation Require long-term applications to control over

inflammation

Offers Rapid relief in pruritic conditions and

steroid responsive dermatoses

Delayed effect in pruritic conditions and steroid

responsive dermatoses

Drug of choice in treatment of Mixed Skin

Infections

Less preferred in treatment of Mixed Skin

Infections due to its delayed effect

Ensures better efficacy & patient compliance Less efficacious hence poor patient compliance

Note – Clobetasol Propionate is a very potent steroid hence it should not be applied on

face.


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35. How Clobetasol propionate works in treatment of mixed skin infections?

It is assumed that, Clobetasol acts by the induction of Phospholipase A2 inhibitory proteins

(Lipocortins). It is assumed that these proteins control the biosynthesis of potent mediators of pain

& inflammation which are Prostaglandins & Leukotrienes by inhibiting the release of their common

precursor Arachidonic Acid. Arachidonic Acid is released from membrane phospholipids by

phospholipase A2. Clobetasol binds to the steroid receptor, forms a complex, enters in to the cell

nucleus and modifies their genetic structure that helps to prevent and control the inflammation.

Diagrammatic representation of Mode of action of Corticosteroids

CORTICOSTEROIDS (After application to the skin)

Steroid receptor complex in the cell (Glucocorticoid Receptor)

Binds to DNA

Transcription /Copy (mRNA protein synthesis)

Synthesis of Lipocortins

Inhibits the enzymes phospholipase A2

Inhibits the release of Prostaglandins & Leukotrienes

Inhibits the formation of Arachidonic acid

Inflammation


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Clobetasol propionate is a high potency corticosteroid that offers quick relief in

inflammatory & pruritic conditions of corticosteroid responsive dermatoses. Hence

it is widely used in combinations with anti-fungal and anti-bacterial, for the

treatment of mixed skin infections.

36. How Mexaderm+ is superior to other competitor brands available in the market?

Mexaderm+ Cream Other brands

Mexaderm+ has a unique microemulsion

cream technology

Ordinary creams prepared with conventional

technology

Cream particle size remains between 10 nm

to 50 nm Particle size greater than 100 nm to 1000 nm

Has enhanced absorption & penetration

across SC Poor penetration & lesser absorption across SC

Offers reservoir effect in the skin that

prevents recurrence

No reservoir effect hence increased risk of

recurrence

Faster action with better efficacy Require long term application hence less

efficacious

Better patient compliance Poor patient compliance

Safe and minimal side effects Causes side effects like redness, burning

sensation & skin sensitization on long term use

37. What are the benefits of Mexaderm+ microemulsion cream?

Mexaderm+ offers, unique microemulsion cream technology for uniform drug delivery and

better penetration of active drugs at the infected area of the skin.

Mexaderm+ offers broad spectrum antifungal with fungicidal effect.

It offers broad spectrum antibacterial coverage and rapid action over both aerobic and

anaerobic bacteria.

Mexaderm+ offers potent anti-inflammatory and anti-pruritic activity with quick and effective

control over pruritus and scaling.

Offers better results in infection treatment with lesser chances of recurrence.

38. What are the indications of Mexaderm+ microemulsion cream?

Mexaderm+ Cream is indicated for the treatment of inflammatory conditions of corticosteroid

responsive dermatoses when complicated by secondary infection caused by fungi or bacteria or by

both causing mixed skin infections.


19

The major indications of Mexaderm+ Cream are as below;

Mixed skin infections

Secondary bacterial skin infections

Secondary fungal skin infections

Superinfected eczematous conditions

39. Which are the key discussion points of Mexaderm+ microemulsion cream?

Mexaderm+ Microemulsion Cream offers,

Unique microemulsion cream technology for uniform drug delivery at the affected site

Broad spectrum antifungal with two antibacterials to cover aerobic and anaerobic bacteria

Strong fungicidal action with reservoir effect in skin up to 12 weeks

Potent anti-inflammatory & anti-pruritic action for quick control of pruritus and scaling

Faster penetration at the site of infection

Rapid onset of action

Quicker clearance of infections

Improved efficacy

Better patients compliance

Offers better results in infection treatment with lesser chances of recurrence.

40. What is the pack size and MRP of Mexaderm + microemulsion cream?

Mexaderm+ Microemulsion Cream is available in 15 gm Lami tube packed in an attractive carton

with the M.R.P. of Rs.55.00/- Incl. of All Taxes.

41. How long the patients can use Mexaderm + Cream?

Mexaderm+ Cream should be applied twice daily on the affected area till complete cure of the

infection, but not for more than two weeks. We suggest it to be used as directed by the physician.

42. In which age group of children Mexaderm + can be used?

Safety and effectiveness of the ingredients in Mexaderm + in children have not been established;

therefore, Mexaderm+ should not be used in children below 12 years of age. It is suggested to use

this preparation as per the doctors / physicians advice.

43. Is there any side effect of Mexaderm + Cream?

Burning, itching, irritation and dry skin eczema are some of the rarely occurring side effects of this

combination.


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44. Can Mexaderm + cream be used in pregnant woman?

There are no adequate and well-controlled studies available regarding the use of this combination

in pregnant women. Hence, Mexaderm+ should be used during pregnancy only if the potential

benefit justifies the potential risk to the fetus.

45. Do patients need to take any precaution while using Mexaderm+ Cream?

This preparation should not be used if the patients who have any known sensitivity or allergy with

any of the ingredients of this preparation. The drug applied area should not be dressed unless

suggested by the doctor.

Clobetasol Propionate is a very potent steroid hence it should not be applied on

face.

46. Which are the major competitors of Mexaderm+ Microemulsion cream?

There are more than 25 brands available containing the similar combination of Ofloxacin,

Ornidazole, Terbinafine and Clobetasol propionate.

As per IMS – MAT Dec ‘2014 data, following are the major competitors of Mexaderm+

Microemulsion Cream.

Brands Marketed By Packing MRP

PANDERM+ Macleods 15 gm 56.00

TERBINAFORCE PLUS Mankind 15 gm 38.00

CANDID TOTAL Glenmark 20 gm 68.00

FUNZI MX Corona 15 gm 49.00

TOTALDERM PLUS Alkem 15 gm 34.00

AFDERM-MX AFD 15 gm 55.00

ORNODERM Aristo 15 gm 39.00

OF DERM JB Chemicals 15 gm 47.00

O2DERM Medley 15 gm 35.00

ORKID Indchemie 15 gm 60.00


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47. What is the size of derma market as a whole in IPM?

Overall derma market is valued around Rs.4886.9Cr which is growing by 19.37% as per IMS MAT

Dec '2014.

The top fast growing categories in Dermatology segment are as below:

TOP 5 CATEGORIES IN DERMA

TOP DERMA GROUPS MAT VALUE in Rs. Cr. MAT UNITS in ‘000 % Growth

Dec ‘2014 Dec ‘2013 Dec ‘2014 Dec ‘2013 Value Units

Cort + Antifung. + Anti-inf. 584.8 461.0 197839.7 173475.1 26.9 14.0

Emollients – Protectives 510.1 398.6 62423.8 55246.3 28.0 13.0

Demelanizing Agents 360.5 317.0 34811.8 32915.1 13.7 5.8

Antiacne Preparations 332.7 294.1 41141.2 39982.6 13.1 2.9

Topical Antibiotics Plain 326.8 280.4 82477.7 76111.7 16.5 8.4

Antifung. Syst. Ex. Gris. 304.2 243.7 121051.8 102334.3 24.8 18.3

Antiseptic – Disinfectant 281.8 270.9 64892.7 64257.7 4.0 1.0

Antifungal – Dermat 276.5 207.2 56479.3 43845.1 33.5 28.8

Cortico + Antifungals 272.6 242.9 81936.4 77605.8 12.2 5.6

The corticosteroid + antifungal + antibacterial, is the biggest category in derma market in terms of

volume and value both. We are currently present in one of the biggest sub-segment with our brand

Tezcort-GM. Now we are entering in the fastest growing sub-segment of the combination market

i.e. Ofloxacin + Ornidazole+ Terbinafine + Clobetasol with Mexaderm+ Microemulsion Cream.

48. What is the market size of the preparations available in treatment of Mixed Skin Infection?

The available market size of the preparations for Mixed Skin infection is Rs.584Cr.

Top 5 Sub Categories of the Preparations for Mixed Skin Infections SUBGROUP MAT Value in Rs. Cr. MAT Units in ‘000 % Growth


Clobet.+ Oflo.+ Orni.+ Terbi. 210.6 120.4 55404.9 34029.4 74.9 62.8

Beclo.+ Neo.+ Clotri. Comb. 170.0 155.9 42708.0 41749.1 9.0 2.3

Oth. Clobetasol + A.fun + A.in 76.7 69.2 25789.8 27109.9 10.8 -4.9

Beta + Genta + Mico. Comb. 42.7 39.8 30283.5 28480.5 7.2 6.3

Clobetasol.+ Gen.+ Mico. 21.6 19.0 18471.1 17309.8 13.3 6.7

Other Cort + Antifung + Antiinf 17.8 12.5 3210.1 2502.0 41.9 28.3

Beclo.+ Genta.+ Clotri. Com 17.0 15.6 6816.6 6809.1 8.9 0.1

Others 28.4 28.4 15155.5 15485.4 -38.9 -2.1

TOTAL 584.8 461.0 197839.7 173475.1 26.9 14.0


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The fastest growing and now the biggest market in the above sub categories is of Clobetasol +

Ofloxacin + Ornidazole + Terbinafine combinations, which is valued around Rs.210.60Cr. and

growing @ 75%. We are launching Mexaderm+ Cream containing the same combination, which is

the top growing combination in mixed skin infection market, with intention to exploit the excellent

opportunity for Glowderma.

49. Which are the top 10 brands in overall Mixed skin infections (Corticosteroid + Antifungal +

Anti-infective) market?

Out of the total 280 + Brands of the above combination, the top 10 brands are as below:

TOP 10 BRANDS - CATEGORY - CORT.+ANTIFUNG+ANTIINF.CO BRANDS MAT Value in Rs. Cr. MAT Units in ‘000 % Growth


Panderm + 165.9 100.9 40879.6 27189.8 64.5 50.3

Quadriderm – RF 86.8 79.4 21288.6 20458.2 9.3 4.1

Lobate – GM-NEO 42.1 38.2 11850.8 11669.2 10.2 1.6

Surfaz –SN 31.5 26.6 8357.1 7577.4 18.5 10.3

Betnovae – GM 30.9 29.0 20620.5 19522.9 6.4 5.6

Cloben – G 19.4 17.9 4520.6 4564.8 8.6 -1.0

Candiderma Plus 16.6 15.8 3523.3 3637.5 5.3 -3.1

Terbinaforce Plus 15.7 10.4 5699.9 3927.6 50.5 45.1

Clop – GM – Neo 9.4 8.8 2595.2 2664.7 6.5 -2.6

Betamil – GM 8.8 7.6 8410.6 7621.7 15.2 10.4

The above 10 Brands Captures 73% Share of the overall Mixed skin infection market.

Panderm + has now become the biggest brand in the entire derma market. The growth is

phenomenal @ 65% this proves that there is tremendous opportunity in this category.

50. What is the market size & market growth of the preparations containing combinations like,

Ornidazole, Ofloxacin, Terbinafine & Clobetasol propionate?

According to IMS – MAT Dec ‘2014 data, the total size of the market containing Ofloxacin,

Ornidazole, Terbinafine & Clobetasol brands is around Rs.210.6 Cr. and the market is

growing by 75%.

TOTAL MARKET – CLOBETASOL + OFLOXACIN + ORNIDAZOLE + TERBINAFINE SUBGROUP MAT Value in Rs. Cr. MAT Units in ‘000 % Growth

CLOBET.+ OFLO.+ ORNI.+TERBI


210.6 120.4 55404.9 34029.4 74.9 62.8


23

TOP BRANDS - CLOBETASOL + OFLOXACIN + ORNIDAZOLE + TERBINAFINE

TOP 10 BRANDS MAT Value in Rs. Cr. MAT Units in ‘000 % Growth


PANDERM+ 165.9 100.9 40879.6 27189.8 64.5 50.3

TERBINAFORCE PLUS 15.7 10.4 5699.9 3927.6 50.5 45.1

CANDID TOTAL 4.8 -- 909.1 -- -- --

FUNZI MX 4.2 3.1 1167.0 820.2 35.3 42.3

TOTALDERM PLUS 4.0 1.6 1647.7 667.6 150.2 146.8

AFDERM-MX 2.9 1.3 770.1 358.1 122.0 115.1

ORNODERM 2.6 -- 1071.8 -- -- --

OF DERM 2.0 1.4 569.5 406.9 49.7 39.9

O2DERM 2.0 0.2 748.6 84.4 794.6 787.1

ORKID 1.5 -- 354.0 -- -- --

TRIBEN-XT 1.3 0.8 554.8 378.9 57.4 46.4

51. What is our objective at Glowderma for Mexaderm+ Cream?

Overall market for the treatment of Mixed Skin Infection preparations is valued around

Rs.584Cr as per IMS MAT Dec’ 2014 data and is growing by 27% with a positive growth

trend.

Based on the present positive growth trend in both value & volume, the expected market

value in the yr. 2015 - 16 would be approx. Rs.741Cr. with total volume of 21 Crore units.

The value & volume growth of CLOBET.+OFLO.+ORNI.+TERBI market in 2015 – 16 would be

approx. Rs.367Cr. with the volume of nearly 8 crores units.

Thus just 0.5% of the entire Mixed skin infection market comes around Rs.4Cr. in Value and

12 Lacs in Units.

In other words

If we can grab the share of just 1% from CLOBET.+ OFLO.+ORNI.+TERBI market, it would

come around Rs.4Cr. in Value and 12 Lacs in Units.

If we think of just 0.5% share from the total segment, it will be approximately 12, 00, 000

(12 Lacs) Units in the year 2015-16.

Further, if we just target only Panderm+ (Valued Rs.166Cr. with 57 Lac Units) and stay

behind it to grab just 2% of its available market, we can make Mexaderm+ a brand of Rs.4Cr

with 12 Lac Units. This is possible with the PCPM of just 500 Units of Mexaderm+.

Hence monthly expected volume would be around 1, 00, 000 (1 Lacs) Units.

The minimum PCPM of Mexaderm+ would be of just 500 Units, which is quite achievable.

Thus we can make Mexaderm + a brand of Rs.4Cr in the launch year itself.


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52. What is the punch line (promotional line) of Mexaderm+ Cream?

Maximum eradication with xtraordinary technology

53. What is the minimum expected PCPM for Mexaderm+ Cream?

The minimum expected PCPM of Mexaderm+ Cream is 500 + Units per BE per month

54. Which are the target doctors for Mexaderm+ Microemulsion Cream?

Mexaderm+ Microemulsion Cream should be promoted to GPs only; it should not

be promoted to dermatologists.

55. What would be the promotional strategy for Mexaderm+ Microemulsion Cream?

To select top potential prescribers for exclusive & wide spread promotion of Mexaderm+.

To generate maximum prescriptions from each selected doctor (GPs) and from the

prescribers of other similar preparations.

To create fast, concrete and wide prescriber base i.e. of minimum 50 prescribers per H.Q.

To generate minimum 10 prescriptions from each GP selected for Mexaderm+ Cream.

Ensuring the maximum availability at retail chemist outlets / chemists.

Build the strong brand identity in the minds of a customer (doctors and chemists).

Innovative launch inputs, regular brand reminder activities, innovative promotional inputs

to create TOM (Top of the mind) awareness.

Create a different value perception of the brand by highlighting the benefits of

Microemulsion cream technology.

Only General Practitioners (GPs)

Major prescribers of Panderm+, Terbinaforce Plus

& Candid Total etc.

Potential prescribers of similar preparations

Prescribers of Triple Combinations

(other than Tezcort-GM)


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56. What would be our communication theme and communication strategy for the promotion of

Mexaderm+ Microemulsion Cream?

Our promotional theme would be ‘The Mextraordinary Solution for Mixed Skin Infections’.

Mexaderm + offers maximum eradication of bacteria (aerobic and anaerobic) involved in

the mixed skin infection with its extra ordinary technology of Microemulsion Cream.

To highlight the benefits of the potent antifungal with a potent steroid to avoid recurrence.

Our punch line (promotional line) for Mexaderm+ Microemulsion Cream would be

“The Mextraordinary edge over Ordinary”

Our communication strategy would be to highlight the maximum benefits of this

extraordinary Microemulsion Cream technology and its advantages over ordinary cream

preparations available in this category.

To highlight the benefits of micro particle size of Mexaderm+ Microemulsion cream and its

faster penetration in to the skin pores compared to ordinary creams available in the market.

Highlight on the benefit of faster results with minimal side effects and maximum patient

compliance.

57. Which are our key promotional points for Mexaderm+ Cream?

Mexaderm+ Microemulsion Cream offers an innovative microemulsion cream technology

that has unique benefits over the other similar combinations available in the market.

o Enhanced absorption & penetration in the Stratum Corneum.

o Lesser accumulation of drug at the affected site.

o Improves the efficacy of the drug.

o Minimizes the side effects.

Mexaderm+ Microemulsion Cream offers the combination of a steroid with an anti-fungal

and the synergistic action of antibacterial to kill the both, aerobic & anaerobic bacteria.

Mexaderm+ Microemulsion Cream offers two broad spectrum antibacterial to cover both

aerobic and anaerobic bacteria.

Mexaderm+ Microemulsion Cream contains very potent steroid Clobetasol to ensure faster

results.

Mexaderm+ Microemulsion Cream offers quick control over infection & itching with

uniform drug delivery.

Mexaderm+ Microemulsion Cream does not cause burning sensation and skin sensitization

after application.

58. Brand Positioning of Mexaderm+ Microemulsion Cream?

In mixed skin infections The Mextraordinary Solution that offers Maximum eradication with

xtraordinary Technology.


26

Mexaderm+ Cream is better solution for maximum eradication of the bacteria (Gram +Ve &

Gram –Ve) and anaerobes involved in Mixed Skin Infections, with the benefit of extraordinary

Microemulsion cream technology.

However the other brands are available with ordinary creams base that require long term

application and has the chances of recurrence.

Glowderma offers additional benefit of Microemulsion for maximum eradication with faster

results, better efficacy with maximum patient compliance.

59. Summary of the key benefits (promotional points) of Mexaderm+ Microemulsion Cream.

Faster penetration at the site of infection

Rapid onset of action

Quicker clearance of infections

Improved efficacy

Better patient compliance

60. What are the launch inputs of Mexaderm+ Cream?

1. Mexaderm+ Product Manual

2. Mexaderm+ Launch Shirt (Formal)

3. Mexaderm+ Clearance Chips

4. Mexaderm+ Visual aid Detailing

5. Mexaderm+ Staircase Dispenser

6. Mexaderm+ Launch Stickers

7. Mexaderm+ Punch Reminder Card

8. Mexaderm+ Availability Card

9. Mexaderm+ Rose Thank You Card

10. Mexaderm Magic Pan – For Second Visit


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61. What are the 2nd, 3rd & further visit inputs plan of Mexaderm+ Cream?

Inputogram Qty/

BE

Visit Plan

1 2 3 4 5 6 7 8 9

Mexaderm Launch Formal Shirt 2

Mexaderm Visual aid 1

Mexaderm Clearance Chips 2

Mexaderm Launch Stickers 50

Mexaderm Availability card 100

Mexaderm Samples --

Mexaderm Rose Thank You

Cards 50

Mexaderm Staircase Dispenser 50

Mexaderm Paper Weight 50

Mexaderm Podium Box 1

Mexaderm Punch Reminder

Cards 100

Mexaderm Launch Pan 1

Mexaderm Launch LBL

Mexaderm Box Dispenser 50

Mexaderm cube dispenser 50

Mexaderm 4 Pack Dispenser 50

Mexaderm Plus signed detailer 1

Mexaderm Plus signed LBL 100

Mexaderm Multifold Detailer 1

Mexaderm Multifold LBL 100

Mexaderm Rx pad 50

Mexaderm tent card 100

Mexaderm chit cube 50


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62. Give the details of Mexaderm+ Indications.

Mexaderm + Cream - Indication Glossary:

Mixed Skin Infections - These are generally the secondary skin infections with itching &

irritation, redness & swelling that are either caused by bacteria and fungi and, or mixed with

both causing restlessness to the concern.

Tinea Infections (Ringworm): The organisms that cause dermatophytoses or tinea infections

are called dermatophytes. The resulting diseases are also often called ringworm (even though

there is no worm involved). The name arose because of the ring-shaped skin patches created by

the infection. These dermatophytoses are caused by Microsporum, Trichophyton, and

Epidermophyton genera of fungi.

o Athlete's foot (Tinea pedis): It is a common fungal infection of toes that usually appears

during warm weather. Either Trichophyton or Epidermophyton usually cause it. These fungi

most commonly grow in the warm, moist areas between the toes. The fungus can produce

mild scaling with or without redness and itching. Sometimes scaling is severe, with

breakdown and painful cracking (fissuring) of the skin. Fluid-filled blisters can also form.

Because the fungus may cause the skin to crack, athlete's foot can lead to bacterial infection

especially in older people and in people with inadequate blood flow to the feet.

o Nail ringworm (Tinea unguium / onychomycosis): It is an infection of the nail most often

caused by Trichophyton. The fungus may get into the nail, producing a thickened, lusterless,

and deformed nail. Infection is more common on the toenails than on the fingernails. An

infected toenail may separate from the toenail bed, crumble, or flake off.


29

o Jock itch (Tinea cruris): It is the common infection develops in the skin folds near the genital

area particularly during warm weather. The infection can spread to the upper inner thighs.

Jock itch can be quite itchy and may be painful. A susceptible person may have repeated

infections.

o Scalp ringworm (Tinea capitis): It is the ringworm (fungal) infection at the scalp caused by

Trichophyton. It may produce a pink scaly rash that may be somewhat itchy, or it may

produce a patch of hair loss without a rash. Less commonly it can cause a painful, inflamed,

swollen patch on the scalp that sometimes oozes pus (a kerion). A kerion is caused by an

allergic reaction to the fungus.

o Body ringworm (Tinea corporis): It is the fungal infection of the body, caused by

Trichophyton, Microsporum, or Epidermophyton. The infection generally produces round

patches with pink scaly borders, clear areas in the center with or without itching. Body

ringworm can develop anywhere on the skin and can spread rapidly to other parts.


30

o Beard ringworm (Tinea barbae): It is the infection at beard area of face. Bacteria, not fungi,

cause most skin infections in the beard area. Tinea barbae is also called as Ringworm of

beard.

o Tinea manuum - A fungal infection of the hands especially on palms.

Atopic Dermatitis - Red, itchy, dry skin which easily rashes; most common in infants; a result of

an exposure to an allergen or an irritant.

Balanitis - inflammation of the head / tip of the penis i.e. at the glans penis.

Contact dermatitis - Contact dermatitis or Irritant dermatitis is a term for a skin reaction

resulting from exposure to allergens (allergic contact dermatitis) or irritants (irritant contact

dermatitis).

Cutaneous candidiasis – It is an infection of the skin caused by Candida fungus.

Dermatophytosis - Infection of the skin caused by fungi called as dermatophytes which grow on

the dead layers of the skin i.e. stratum corneum / Keratinophilic. (Especially at the moist parts

that are covered by clothing).

Eczema in children - A patterned form of inflammation of the skin resulting from endogenous

(within body) or exogenous (outside body) causes.

Ichthyosis - any of several acquired or congenital diseases where the skin is dry & scaly (like

scales of a fish).

Inflammatory skin conditions - any skin diseases showing redness, swelling, and pain or itching

and often scaling.

Intertrigo - An intertrigo is an inflammation (rash) of the body folds (adjacent areas of skin).


31

Onycomycosis - A fungal infection that affects the fingernails or toenails. It can be caused by

Dermatophytes or moulds or yeasts.

Otomycosis - (also known as Singapore Ear) is a fungal infection of the external ear.

Post herpetic neuralgia - a severe, sometimes relentless pain that follows an attack of

shingles/herpes zoster. It occurs primarily in the older population groups.

Seborrhoeic dermatitis - A common, inflammatory skin condition that causes flaky, white to

yellowish scales to form on oily areas such as the scalp or inside the ear or eyelids. It can occur

with or without reddened skin" OR Seborrhoeic dermatitis has been called a more extensive

and severe form of dandruff.

Skin & Soft tissue infections – It is the infection of skin or subcutaneous tissue.

Super infected eczemas – A condition of Eczemas which can get secondarily infected with

bacteria or fungi.

Vulvo Vaginitis -Inflammation of the vagina and vulva most often caused by the bacterial,

fungal, or parasitic infection.

Vulvar itching – Irritation & itching of vulva caused by bacterial, fungal, or parasitic infection.

Vaginal candidiasis: It is infection of the vagina and /or vulva with a yeast-like fungus, typically

Candida albicans. Symptoms may include pain, itching, redness and a white discharge. Vaginal

candidiasis is more common and more difficult to treat in HIV positive women; recurrent

episodes may be an early sign of HIV infection.

Candidal Balanitis: It is an inflammation of the end of the penis (the glans). Often the foreskin is

also inflamed at the same time as the glans. (The foreskin is the loose skin that covers the glans

if not circumcised.) Balanitis is common, and it can occur at any age. Symptoms include

redness, irritation, and soreness of the end of the penis.

Dermatomycosis: It is one of the most frequent dermal lesions in which, except the skin,

dermal appendages viz. hair and nails also get affected. Such as, Tinea pedis, Tinea corporis,

Tinea unguium (onychomycosis), and dermal candida infections.

Bacterial Infections of Skin:

Staph Infection: Staph is short name for Staphylococcus bacteria which can live harmlessly on

many skin surfaces, especially around the nose, mouth, genitals, and anus. But when the skin is

punctured or broken for any reason, staph bacteria can enter the wound and cause an

infection. The staph family of bacteria has more than 30 species, but most staph infections are

caused by the species Staphylococcus aureus. S. aureus most commonly causes skin infections

like folliculitis, boils, impetigo, and cellulitis that are limited to a small area of a person's skin.

People with skin problems like burns or eczema may be more likely to get staph skin infections.

It is contagious and can spread to other body parts and in other people coming in contact with

infected person.


32

Carbuncle: A carbuncle is a bacterial infection of skin mainly caused by Staphylococcus aureus.

The infected material forms a lump, which occurs deep in to the skin. A carbuncle is made up of

several skin boils (furuncles) involving group of hair follicles. The infected mass is filled with

fluid, pus and dead tissue. Fluid may drain out of the carbuncle, but sometimes the mass is so

deep that it cannot drain on its own.

When there is more than one carbuncle, the condition is called carbunculosis (secondary

bacterial infection). It is contagious and can spread to other areas of the body or other people.

Carbuncles can develop anywhere on skin. But they are most common on the back and the

nape of the neck. Men get carbuncles more often than women. The causes may be the friction

from clothing or shaving, poor hygiene, poor overall health and in the person with diabetes,

dermatitis, and weakened immune systems are more likely to develop staph infections that can

cause carbuncles.

Boils: A boil is common a bacterial skin infection caused by Staphylococcus aureus that affects

group of hair follicles and nearby skin tissues. A boil may begin as a tender, pinkish-red,

swollen, firm area in the skin. It is painful and feels like a water-filled balloon or cyst.


33

When the condition worsens (secondary bacterial infection) it is known as carbunculosis &

folliculitis. They can also be caused by other type bacteria or fungi found on the skin's surface

causing mixed skin infection. Damage to the hair follicle allows the infection to grow deeper

into the follicle and the tissues under it. Boils are most common on the face, neck, armpit,

buttocks, and thighs. There can be one or many boils. Pain gets worse as it fills with pus and

dead tissue.

Impetigo: Impetigo is a skin infection caused by bacteria. It is usually caused by staphylococcal

bacteria, but it can also be caused by streptococcal bacteria. It is most common in children

between the ages of two and six. It usually starts when bacteria get into a break in the skin,

such as a cut, scratch, or insect bite.

Symptoms of impetigo start with red or pimple-like sores surrounded by red skin. These sores

can be anywhere, but usually they occur on face, arms and legs. The sores fill with pus, then

break open after a few days and form a thick crust. They are often itchy, but scratching them

can spread the sores. Impetigo can spread by contact with sores or nasal discharge from an

infected person.

Pilonidal Cyst: It is an abnormal pocket in the skin that usually contains hair and skin debris. A

pilonidal cyst found always located near the tailbone at the top of the cleft of the buttocks.


34

These cysts occur when hair punctures the skin and then becomes embedded. If a pilonidal cyst

becomes infected, the resulting abscess is often extremely painful.

Pilonidal cysts most commonly occur in young men and the problem has a tendency to recur.

People who sit for prolonged periods of time, such as truck drivers, are at higher risk of

developing a pilonidal cyst. When it is infected it becomes a swollen mass (abscess) with pain,

redness, drainage of pus or blood from an opening in the skin and foul smell from draining pus.

Cellulitis: It is an infection of the skin and its deep underlying tissues and is commonly caused

by group A Streptococcal bacteria. The bacteria enter in the body when there is an injury, such

as a bruise, burn, surgical cut, or wound. It starts with fever and chills, swollen glands or lymph

nodes, a rash with painful, red, tender skin. The skin may blister and scab over.

ALL THE BEST!!!

medico-marketing manualglowderma.co.in/mailfiles/circular1.pdftinea capitis: (ring worm of scalp) -...

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